Associations of Early Kidney Disease With Brain Magnetic Resonance Imaging and Cognitive Function in African Americans With Type 2 Diabetes Mellitus

AA-DHS MIND and ACCORD MIND Investigators

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Relationships between early kidney disease, neurocognitive function, and brain anatomy are poorly defined in African Americans with type 2 diabetes mellitus (T2DM). Study Design Cross-sectional associations were assessed between cerebral anatomy and cognitive performance with estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) in African Americans with T2DM. Setting & Participants African Americans with cognitive testing and cerebral magnetic resonance imaging (MRI) in the African American−Diabetes Heart Study Memory in Diabetes (AA-DHS MIND; n = 512; 480 with MRI) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) MIND (n = 484; 104 with MRI) studies. Predictors eGFR (CKD-EPI creatinine equation), spot UACR. Measurements MRI-based cerebral white matter volume (WMV), gray matter volume (GMV), and white matter lesion volume; cognitive performance (Mini-Mental State Examination, Digit Symbol Coding, Stroop Test, and Rey Auditory Verbal Learning Test). Multivariable models adjusted for age, sex, body mass index, scanner, intracranial volume, education, diabetes duration, hemoglobin A1c concentration, low-density lipoprotein cholesterol concentration, smoking, hypertension, and cardiovascular disease were used to test for associations between kidney phenotypes and the brain in each study; a meta-analysis was performed. Results Mean participant age was 60.1 ± 7.9 (SD) years; diabetes duration, 12.1 ± 7.7 years; hemoglobin A1c concentration, 8.3%±1.7%; eGFR, 88.7 ± 21.6 mL/min/1.73 m2; and UACR, 119.2 ± 336.4 mg/g. In the fully adjusted meta-analysis, higher GMV associated with lower UACR (P < 0.05), with a trend toward association with higher eGFR. Higher white matter lesion volume was associated with higher UACR (P < 0.05) and lower eGFR (P < 0.001). WMV was not associated with either kidney parameter. Higher UACR was associated with lower Digit Symbol Coding performance (P < 0.001) and a trend toward association with higher Stroop interference; eGFR was not associated with cognitive tests. Limitations Cross-sectional; single UACR measurement. Conclusions In African Americans with T2DM, mildly high UACR and mildly low eGFR were associated with smaller GMV and increased white matter lesion volume. UACR was associated with poorer processing speed and working memory.

Original languageEnglish (US)
Pages (from-to)627-637
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume70
Issue number5
DOIs
StatePublished - Nov 1 2017

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Kidney Diseases
African Americans
Type 2 Diabetes Mellitus
Cognition
Creatinine
Albumins
Magnetic Resonance Imaging
Glomerular Filtration Rate
Urine
Brain
Meta-Analysis
Anatomy
Hemoglobins
Stroop Test
Kidney
Verbal Learning
Short-Term Memory
LDL Cholesterol
Body Mass Index
Cardiovascular Diseases

Keywords

  • African American
  • albuminuria
  • brain
  • chronic kidney disease (CKD)
  • cognitive performance
  • estimated glomerular filtration rate (eGFR)
  • magnetic resonance imaging (MRI)
  • neurocognitive function
  • type 2 diabetes mellitus (T2DM)
  • urine albumin-creatinine ratio (UACR)

ASJC Scopus subject areas

  • Nephrology

Cite this

Associations of Early Kidney Disease With Brain Magnetic Resonance Imaging and Cognitive Function in African Americans With Type 2 Diabetes Mellitus. / AA-DHS MIND and ACCORD MIND Investigators.

In: American Journal of Kidney Diseases, Vol. 70, No. 5, 01.11.2017, p. 627-637.

Research output: Contribution to journalArticle

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abstract = "Background Relationships between early kidney disease, neurocognitive function, and brain anatomy are poorly defined in African Americans with type 2 diabetes mellitus (T2DM). Study Design Cross-sectional associations were assessed between cerebral anatomy and cognitive performance with estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) in African Americans with T2DM. Setting & Participants African Americans with cognitive testing and cerebral magnetic resonance imaging (MRI) in the African American−Diabetes Heart Study Memory in Diabetes (AA-DHS MIND; n = 512; 480 with MRI) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) MIND (n = 484; 104 with MRI) studies. Predictors eGFR (CKD-EPI creatinine equation), spot UACR. Measurements MRI-based cerebral white matter volume (WMV), gray matter volume (GMV), and white matter lesion volume; cognitive performance (Mini-Mental State Examination, Digit Symbol Coding, Stroop Test, and Rey Auditory Verbal Learning Test). Multivariable models adjusted for age, sex, body mass index, scanner, intracranial volume, education, diabetes duration, hemoglobin A1c concentration, low-density lipoprotein cholesterol concentration, smoking, hypertension, and cardiovascular disease were used to test for associations between kidney phenotypes and the brain in each study; a meta-analysis was performed. Results Mean participant age was 60.1 ± 7.9 (SD) years; diabetes duration, 12.1 ± 7.7 years; hemoglobin A1c concentration, 8.3{\%}±1.7{\%}; eGFR, 88.7 ± 21.6 mL/min/1.73 m2; and UACR, 119.2 ± 336.4 mg/g. In the fully adjusted meta-analysis, higher GMV associated with lower UACR (P < 0.05), with a trend toward association with higher eGFR. Higher white matter lesion volume was associated with higher UACR (P < 0.05) and lower eGFR (P < 0.001). WMV was not associated with either kidney parameter. Higher UACR was associated with lower Digit Symbol Coding performance (P < 0.001) and a trend toward association with higher Stroop interference; eGFR was not associated with cognitive tests. Limitations Cross-sectional; single UACR measurement. Conclusions In African Americans with T2DM, mildly high UACR and mildly low eGFR were associated with smaller GMV and increased white matter lesion volume. UACR was associated with poorer processing speed and working memory.",
keywords = "African American, albuminuria, brain, chronic kidney disease (CKD), cognitive performance, estimated glomerular filtration rate (eGFR), magnetic resonance imaging (MRI), neurocognitive function, type 2 diabetes mellitus (T2DM), urine albumin-creatinine ratio (UACR)",
author = "{AA-DHS MIND and ACCORD MIND Investigators} and Freedman, {Barry I.} and Sink, {Kaycee M.} and Hugenschmidt, {Christina E.} and Hughes, {Timothy M.} and Williamson, {Jeff D.} and Whitlow, {Christopher T.} and Palmer, {Nicholette D.} and Miller, {Michael E.} and Lovato, {Laura C.} and Jianzhao Xu and Smith, {S. Carrie} and Launer, {Lenore J.} and Barzilay, {Joshua I.} and Cohen, {Robert M.} and Sullivan, {Mark D.} and Bryan, {R. Nick} and Wagner, {Benjamin C.} and Bowden, {Donald W.} and Maldjian, {Joseph A} and Jasmin Divers",
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TY - JOUR

T1 - Associations of Early Kidney Disease With Brain Magnetic Resonance Imaging and Cognitive Function in African Americans With Type 2 Diabetes Mellitus

AU - AA-DHS MIND and ACCORD MIND Investigators

AU - Freedman, Barry I.

AU - Sink, Kaycee M.

AU - Hugenschmidt, Christina E.

AU - Hughes, Timothy M.

AU - Williamson, Jeff D.

AU - Whitlow, Christopher T.

AU - Palmer, Nicholette D.

AU - Miller, Michael E.

AU - Lovato, Laura C.

AU - Xu, Jianzhao

AU - Smith, S. Carrie

AU - Launer, Lenore J.

AU - Barzilay, Joshua I.

AU - Cohen, Robert M.

AU - Sullivan, Mark D.

AU - Bryan, R. Nick

AU - Wagner, Benjamin C.

AU - Bowden, Donald W.

AU - Maldjian, Joseph A

AU - Divers, Jasmin

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background Relationships between early kidney disease, neurocognitive function, and brain anatomy are poorly defined in African Americans with type 2 diabetes mellitus (T2DM). Study Design Cross-sectional associations were assessed between cerebral anatomy and cognitive performance with estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) in African Americans with T2DM. Setting & Participants African Americans with cognitive testing and cerebral magnetic resonance imaging (MRI) in the African American−Diabetes Heart Study Memory in Diabetes (AA-DHS MIND; n = 512; 480 with MRI) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) MIND (n = 484; 104 with MRI) studies. Predictors eGFR (CKD-EPI creatinine equation), spot UACR. Measurements MRI-based cerebral white matter volume (WMV), gray matter volume (GMV), and white matter lesion volume; cognitive performance (Mini-Mental State Examination, Digit Symbol Coding, Stroop Test, and Rey Auditory Verbal Learning Test). Multivariable models adjusted for age, sex, body mass index, scanner, intracranial volume, education, diabetes duration, hemoglobin A1c concentration, low-density lipoprotein cholesterol concentration, smoking, hypertension, and cardiovascular disease were used to test for associations between kidney phenotypes and the brain in each study; a meta-analysis was performed. Results Mean participant age was 60.1 ± 7.9 (SD) years; diabetes duration, 12.1 ± 7.7 years; hemoglobin A1c concentration, 8.3%±1.7%; eGFR, 88.7 ± 21.6 mL/min/1.73 m2; and UACR, 119.2 ± 336.4 mg/g. In the fully adjusted meta-analysis, higher GMV associated with lower UACR (P < 0.05), with a trend toward association with higher eGFR. Higher white matter lesion volume was associated with higher UACR (P < 0.05) and lower eGFR (P < 0.001). WMV was not associated with either kidney parameter. Higher UACR was associated with lower Digit Symbol Coding performance (P < 0.001) and a trend toward association with higher Stroop interference; eGFR was not associated with cognitive tests. Limitations Cross-sectional; single UACR measurement. Conclusions In African Americans with T2DM, mildly high UACR and mildly low eGFR were associated with smaller GMV and increased white matter lesion volume. UACR was associated with poorer processing speed and working memory.

AB - Background Relationships between early kidney disease, neurocognitive function, and brain anatomy are poorly defined in African Americans with type 2 diabetes mellitus (T2DM). Study Design Cross-sectional associations were assessed between cerebral anatomy and cognitive performance with estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) in African Americans with T2DM. Setting & Participants African Americans with cognitive testing and cerebral magnetic resonance imaging (MRI) in the African American−Diabetes Heart Study Memory in Diabetes (AA-DHS MIND; n = 512; 480 with MRI) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) MIND (n = 484; 104 with MRI) studies. Predictors eGFR (CKD-EPI creatinine equation), spot UACR. Measurements MRI-based cerebral white matter volume (WMV), gray matter volume (GMV), and white matter lesion volume; cognitive performance (Mini-Mental State Examination, Digit Symbol Coding, Stroop Test, and Rey Auditory Verbal Learning Test). Multivariable models adjusted for age, sex, body mass index, scanner, intracranial volume, education, diabetes duration, hemoglobin A1c concentration, low-density lipoprotein cholesterol concentration, smoking, hypertension, and cardiovascular disease were used to test for associations between kidney phenotypes and the brain in each study; a meta-analysis was performed. Results Mean participant age was 60.1 ± 7.9 (SD) years; diabetes duration, 12.1 ± 7.7 years; hemoglobin A1c concentration, 8.3%±1.7%; eGFR, 88.7 ± 21.6 mL/min/1.73 m2; and UACR, 119.2 ± 336.4 mg/g. In the fully adjusted meta-analysis, higher GMV associated with lower UACR (P < 0.05), with a trend toward association with higher eGFR. Higher white matter lesion volume was associated with higher UACR (P < 0.05) and lower eGFR (P < 0.001). WMV was not associated with either kidney parameter. Higher UACR was associated with lower Digit Symbol Coding performance (P < 0.001) and a trend toward association with higher Stroop interference; eGFR was not associated with cognitive tests. Limitations Cross-sectional; single UACR measurement. Conclusions In African Americans with T2DM, mildly high UACR and mildly low eGFR were associated with smaller GMV and increased white matter lesion volume. UACR was associated with poorer processing speed and working memory.

KW - African American

KW - albuminuria

KW - brain

KW - chronic kidney disease (CKD)

KW - cognitive performance

KW - estimated glomerular filtration rate (eGFR)

KW - magnetic resonance imaging (MRI)

KW - neurocognitive function

KW - type 2 diabetes mellitus (T2DM)

KW - urine albumin-creatinine ratio (UACR)

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U2 - 10.1053/j.ajkd.2017.05.006

DO - 10.1053/j.ajkd.2017.05.006

M3 - Article

VL - 70

SP - 627

EP - 637

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 5

ER -